HHSC Uniform Managed Care manual /
3.16
/ 1 of 3CHAPTER TITLE / Effective Date
STAR Health MEMBER ID CARD REQUIRED CRITICAL ELEMENTS / December 10, 2014
Version 2.1
DOCUMENT HISTORY LOG
STATUS1 / DOCUMENT
REVISION2 / EFFECTIVE
DATE / DESCRIPTION3
Baseline / n/a / December 31, 2007 / Initial version Uniform Managed Care Manual Chapter 3.16, STAR Health Member ID Card Required Critical Elements
Revision / 2.0 / March 1, 2012 / Revision 2.0 applies to contracts issued as a result of HHSC RFP number 529-06-0293.
Chapter is reformatted for consistency with other Required Critical Elements Chapters.
Add HHSC’s required language regarding emergencies (Attachment A)
Revision / 2.1 / December 10, 2014 / Chapter 3.16 is modified to add Pharmacy Benefit Manager (PBM) pharmacy billing information to the Member ID cards.
1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions
2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision.
3 Brief description of the changes to the document made in the revision.
Applicability: This chapter applies to Health Maintenance Organizations (HMOs) and Managed Care Organizations (MCOs) (collectively Managed Care Organizations (MCOs)) participating in the Comprehensive Healthcare Program for Foster Care (STAR Health). This chapter sets forth the Member ID card requirements for STAR Health Program Members.
Required Critical Element
/Check if included
Member’s Name
Member’s Medicaid Number
Effective Date of the Primary Care Provider (PCP) Assignment
PCP’s Name and Telephone Number
Service Coordination Telephone Number
Name of the MCO
24 hour / 7 days a week Toll-Free Member Services Telephone Number
24 hour / 7 days a week Toll-Free Behavioral Health Services Hotline
Directions for what to do in case of an emergency (MCO must use HHSC’s provided language – Attachment A)
A statement that identifies the program, i.e. STAR Health
Member Information (anything intended for the Member to read) must be translated into Spanish
Pharmacy Benefit Manager (PBM) Entity Name (if different from the MCO)Pharmacy Benefit Manager (PBM) Bank Identification Number (BIN)
PBM Processor Control Number (PCN)
PBM Group Identification Number (Group ID)
Optional:
- Date of Birth
- PCP’s address
Required Language
ATTACHMENT A
Directions for what to do in an emergency.
In case of emergency call 911 or go to the closest emergency room. After treatment, call your PCP within 24 hours or as soon as possible.
Instrucciones en caso de emergencia.
En caso de emergencia, llame al 911 o vaya a la sala de emergencias más cercana. Después de recibir tratamiento, llame al PCP dentro de 24 horas o tan pronto como sea posible.